Female Flashcards
Nonpharm approaches for PMS
Lifestyle modifications
- relaxation and stress reduction
Dietary modifications
-caffeine restriction
-small frequen5 carb servings
-restrict salt intake in literal phase (helps with water retention)
Pharm approaches for PMS
Pyridoxine (b6)
NSAIDs - pain
Low dose calcium 400-500mg says helps
High dose calcium 1200mg = water retention
Magnesium 200-400mg t/o menstrual cycle to help fluid retention
If wishes contraceptives
- COC
SSRI - offers short term benefit
-can take continuously or only during luteal phase
Absolute CI to COC
MY CUPLETS
My- Migraines with aura
C- CAD/ CVA
U-undiagnosed vaginal bleeding
P-pregnant or suspect pregnancy
L-liver tumor or active liver disease
E-estrogen dependent cancer
T-thrombus or emboli
S-smoker aged 35 or older or >15cigs/day
Nuvaring how does it work
What happens if ring fell out >3 hours
1 ring inserted vaginally x 3 weeks and then removed for 1 week
Use backup contraception , reinsert ring
They are considered CHC
Transdermal patch how does it work
Decreased efficacy if >90 kg
Apply 1 patch weekly x3 weeks then 1 week off
They are CHC
Progestin only pill
For: >35 who smoke, cannot tolerate estrogen, have unwanted side effects of COC, experience migraines headaches with neurological symptoms or are breastfeeding
What happens if you miss a pill?
If >3 hours late , use backup
Depot provera injection , how often do you inject ?
What must you educate your pts on ?
Injection Q12weeks, no hormone free interval
Osteoporosis risk factor
- adequate weight bearing exercise and calcium/ vitamin D intake, smoking cessation
Progestin implant (nexplanon)
Removal rod implanted every 3 years
Progestin only
IUD - levonorgestrel
How long can they stay in?
What are side effects
5 years
Occasional bleeding for first 3 months after insertion, eventual amenorrhea in 20-30% of patients
Emergency postcoital contraception options ?
- Single dose levonorgestrel 1.5mg (plan B)
-highest efficacy in first 24 hrs can take up to 5 days
They say less effective if you weigh 75-80kg but use irrespective of wt
2. Ulipristal acetate 30mg x1
-take within 5 days of unprotected sex
3. Copper IUD
-most effective, up to 7 days of unprotected sex
-first line if BMI >30 as it is not affected
What are CHCs danger signs?
ACHES
What happens if you took plan B and you vomited ?
If <2 hours after taking then you can repeat dose
If > then do not
Contraceptives postpartum?
Progestin only (esp. if breastfeeding)
-lower risk of thromboembolism in first 6 weeks compared to COC and can be introduced immediately after delivery
Avoid COC in first 6 weeks or if BF
If not BF could do COC at 3 weeks PP
Could also do IUD
Medical abortion when can you terminate this way
What should you do when someone says they are pregnant?
</- 63 days (9 weeks)
Confirm and establish GA through beta HCG and / or ultrasound
Ultrasound is gold standard
Uncontrolled asthma
Long term corticosteroid use
CI to medical abortions?
Confirmed ectopic pregnancy
IUD in place
Hemorrhagic disorders or using anticoagulants
Anemia <95
Known hypersensitivity to drugs
Ambivalence
Pharm approaches to medical abortion
Mifepristone and misoprostol
Mifepristone 200mg PO
Then,
Misoprostol 800mcq buccal 24-48hrs later
What is expected with medical abortion
What are red flags
-Heavier bleeding than what is expected for menses
-usually starts within a few hours of Misoprostol admin
Red flags:
>2 pads per hour for 2 consecutive hours or 1 pad per hour x 10 hours straight
Pt feeling dizzy, lightheaded, racing heart >24hrs
You must go to ER
When do you follow up in clinic after medical abortion?
At day 7 post treatment ( >80% beta drop) = abortion complete
Or
Day 3 ( >50% beta drop)
Side note:
Urine beta may still be detected in brine >4 weeks after MA
Ultrasound is best but not necessary, use if having unexpected pain, prolonged heavy bleeding or inadequate bleeding
Should advise pt who completed MA to avoid becoming pregnant during next menses to avoid inadvertent exposure of the pregnancy to abort meds
OCP can start on day of Misoprostol
Fertility is restored 8 days post MA
Risk factors for ectopic pregnancy
Precious ectopic
Total surgery or ligation
PID
Pregnancy with IUD
Assisted reproductive techniques used to conceive
A 35-year-old woman smokes approximately 10 cigarettes per day. She started smoking at age 18 years. She has a new male sexual partner and is interested in contraception. She was recently treated for gonorrhea and chlamydia. She is using condoms inconsistently. The urine pregnancy test is negative. She denies a history of hypertension, blood clots, liver disease, heart disease, and diabetes. Her last menstrual period was 5 days ago. Which of the following contraceptive methods is recommended?
A.Oral contraceptive pills
B.Copper intrauterine device (IUD)
C.Etonogestrel implant (Nexplanon)
D.Vaginal ring (NuvaRing)
Answer: C. Etonogestrel implant (Nexplanon)
An etonogestrel implant (Nexplanon) is the best option for this patient. It is a progesterone-only method. The 35-year-old patient is a smoker, so she cannot take oral contraceptives, which contain estrogen/progesterone. An IUD is contraindicated until the patient is retested (4-6 weeks after treatment) to ensure that her gonorrhea and chlamydia infections are gone. The vaginal ring (NuvaRing) contains estrogen and progestin; it is contraindicated for this patient.
